| NPI | 1912281262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV cp-5270-R) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401223735) |
| 101YP2500X Counselor, Professional (Licence: AK pcop878) | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2026-08-11 |